Journal Mobile Options
Table of Contents
Vol. 118, No. 2-4, 1999
Issue release date: February–April 1999
Int Arch Allergy Immunol 1999;118:403–407

Environmental Risk Factors for Respiratory and Skin Atopy: Results from Epidemiological Studies in Former East and West Germany

Ring J. · Krämer U. · Schäfer T. · Abeck D. · Vieluf D. · Behrendt H.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


The fall of the Berlin wall in 1989 offered the unique opportunity to compare populations of a similar genetic and geographic background which had been living under quite different environmental exposure conditions for over 40 years. Since 1990 comparative epidemiological studies were performed between various regions in former East and West Germany with yearly questionnaires and 3 years’ physical, dermatological, allergological and exposure examination in a total of about 30,000 preschool children. There were striking differences between the various German regions with higher prevalence rates of respiratory atopy (hay fever, asthma) and atopic sensitization (prick test, RAST) in West Germany, while atopic eczema was significantly higher in East Germany (17.5 vs. 11.4% in West Germany). Total serum IgE levels were markedly higher in children in the east of Germany, similarly to the prevalence of parasitic infestation (questionnaire data as well as positive ascaris RAST). In multivariate logistic regression analysis the following factors were significantly associated with atopic eczema: animal contact (odds ratio, OR 2.9), animal furs in the bedroom (OR 2.2), use of gas without ventilation (OR 1.7) and living near road with heavy traffic (OR 1.7). Furthermore, socioeconomic factors measured as parental educational status (university vs. elementary school) were significantly associated (OR 2.3) with atopy. Respiratory tract infections and irritant responses decreased together with decreasing SO2 and suspended particulate air pollution in East Germany from 1991 to 1997. It is concluded that environmental factors from the physical, chemical, biological, and psychological environment (characteristic of a ‘modern’ or ‘western’ society) do influence the development of atopic sensitization and disease.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Bascom R, Bromberg PA, Costa DA, et al: State of the art: Health effects of outdoor air pollution. Part I. Am J Respir Crit Care Med 1996;153:3–50.
  2. Behrendt H, Becker WM, Friedrich KH, Darsow U, Tomingas R: Interaction between aeroallergens and airborne particulate matter. Int Arch Allergy Immunol 1992;99:425–428.
  3. Behrendt H, Becker WM, Fritzsche C, Sliwa–Tomczok W, Tomczok J, Friedrichs KH, Ring J: Air pollution and allergy: Experimental studies on modulation of allergen release from pollen by air pollutants. Int Arch Allergy Immunol 1997;113:69–74. 3a Behrendt H, Friedrichs K, Kainka–Staenicke E, Darsow U, Becker W, Tomingas R: Allergens and pollutants in the air – A complex interaction; in Ring J, Przybilla B (eds): New Trends in Allergy III. Berlin, Springer, 1991, pp 467–478.
  4. Behrendt H, Friedrichs KH, Krämer U, Hitzfeld B, Becker WM, Ring J: The role of indoor and outdoor air pollution in allergic diseases. Prog Allergy Clin Immunol 1995;3:83– 89.
  5. Behrendt H, Krämer U, Dolgner R, Hinrichs J, Willer H, Hagenbeck H, Schlipköter HW: Elevated levels of total serum IgE in East German children: Atopy, parasites, or pollutants? Allergo J 1993;2:31–40.
  6. Björkstén B: Genetic and environmental interaction in children. Prog Allergy Clin Immunol 1995;3:97–103.
  7. Brunekreef B, Janssen NAH, de Hartog J, Marssema H, Knape M, van Vliet P: Air pollution from truck traffic and lung function in children living near motorways. Epidemiology 1997;8:298–303.
  8. Burney PGJ, Luczynska C, Chinn S, Jarvis D: The European Community Respiratory Health Survey. Eur Respir J 1994;7:954–960.
  9. Devalia JL, Rusznak C, Herdman MJ, Trigg CJ, Tarraf H, Davies RJ: Effect of nitrogen dioxide and sulfur dioxide on airway response of mild asthmatic patients to allergen inhalation. Lancet 1994;344:1668–1671.
  10. Diaz–Sanchez D, Tsien A, Casillas A, Dotson AR, Saxon A: Enhanced nasal cytokine production in human beings after in vivo challenge with diesel exhaust particles. J Allergy Clin Immunol 1996;98:114–123.
  11. Krämer U, Altmann L, Behrendt H, Dolgner R, Islam MS, Kaysers HG, Ring J, Stiller–Winkler R, Turfeld M, Weishoff–Houben M, Willer H, Winneke G: Comparison of the influence of socioeconomic factors on air pollution health effects in West and East Germany. Air Pollution Epidemiology Report Series, No 8: Socioeconomic and Cultural Factors in Air Pollution Epidemiology. Brussels, European Commission, 1997, pp 41–49. 11a Krämer U, Altus C, Behrendt H, Dolgner R, Gutsmuths FJ, Hille J, Hinrichs J, Mangold M, Paetz B, Ranft U, Röpke H, Teichmann S, Willer HJ, Schlipköter HW: Epidemiological investigations of health effects of ambient air in school beginners. Forum Städtehyg 1993; 43:82–87.
  12. Krämer U, Schäfer T, Behrendt H, Ring J: The influence of cultural and educational factors on the validity of symptom and diagnosis questions for atopic eczema. J Dermatol, in press. 12a Krämer U, Behrendt H, Ring J: Air pollution as a risk factor for allergy: The East–West German experience; in Ring J, Behrendt H, Vieluf D (eds): New Trends in Allergy IV. Berlin, Springer, 1997, pp 25–35.
  13. Kuehr J, Frischer T, Karmaus W, Menert R, Barth R, Urbanek R: Clinical atopy and associated factors in primary school pupils. Allergy 1992;47:650–655.
  14. Larrick JW, Buckley CE, Machamer CE, Schlagel GD, Yost JA, Blessign–Moore J, Jevy D: Does hyperimmunoglobulinemia–E protect tropical populations from allergic disease? J Allergy Clin Immunol 1983;71:184–188.
  15. Magnussen H, Jörres R, Wagner HM, von Nieding G: Relationship between the airway response to inhaled sulfur dioxide, isocapnic hyperventilation and histamine in asthmatic subjects. Int Arch Occup Environ Health 1990; 62:485.

    External Resources

  16. Mitchell EA, Stewart AW, Pattemore PK, Asher MI, Marrison AC, Rea HH: Socioeconomic status in childhood asthma. Int J Epidemiol 1989;18:888–890.
  17. Miyamoto T, Takafuji S: Environment and allergy; in Ring J, Przybilla B (eds): New Trends in Allergy III. Berlin, Springer, 1991, pp 459– 468.
  18. Peters A, Goldstein IF, Beyer U, Franke K, Heinrich J, Dockery DW, Spengler JD, Wichmann H: Acute health effects of exposure to high levels of air pollution in Eastern Europe. Am J Epidemiol 1996;144:570–581.
  19. Ring J: Epidemiologie allergischer Erkrankungen. Munich, MMV, 1991.
  20. Ring J, Behrendt H, Schäfer T, Vieluf D, Krämer U: Impact of pollution in allergic diseases. Clinical and epidemiological studies. Prog Allergy Immunol 1995;3:174–182.
  21. Ring J, Behrendt H, Vieluf D: New Trends in Allergy IV together with Environmental Allergy Allergotoxicology III. Berlin, Springer, 1997.
  22. Ring J, Behrendt H: Allergy and IgE production: Role of infection and environmental pollution. Allergo J 1993;2:27–30.
  23. Ring J: Allergy and modern society: Does ‘western life style’ promote the development of allergies? Int Arch Allergy Immunol 1997; 113:7–10.

    External Resources

  24. Rusnak C: The impact of pollution on allergic disease. Allergy 1994;49:21–27.
  25. Schäfer T, Vieluf D, Behrendt H, Krämer U, Ring J: Atopic eczema and other manifestations of atopy: Results of an East–West–German comparison. Allergy 1996;51:532–539.

    External Resources

  26. Schlipköter HW, Krämer U, Behrendt H, Dolgner R, Stiller–Winkler R, Ring J, Willer HJ: Impact of air pollution on children’s health. Results from Saxony–Anhalt and Saxony as compared to North Rhine–Westphalia; in Health and ecological Effects. Critical Issues in the Global Environment. Pittsburgh, Air and Waste Management Association, 1992, vol 5, IU–A 2103.
  27. Schultz–Larsen F, Holm NV, Henningsen K: Atopic dermatitis. A genetic–epidemiologic study in a population based twin sample. J Am Acad Dermatol 1986;15:487–494.
  28. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee: Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet 1998;351:1225–1232.
  29. von Mutius E, Fritzsch C, Weiland SK, Röll G, Magnussen H: Prevalence and asthma and allergic disorders among children in united Germany: A descriptive comparison. Br Med J 1992;305:1395–1399.
  30. von Mutius E, Fernando DM, Fritsch C, Nicolai T, Reitmeir P, Thiemann HH: Skin test reactivity and number of siblings. BMJ 1994;308: 692–695.
  31. von Mutius E, Illi S, Nicolai T, Martinez F: Relation of indoor heating with asthma, allergic sensitization, and bronchial hyperresponsiveness: Survey of children in South Bavaria. BMJ 1996;312:1448–1450.
  32. von Mutius E, Martinez F, Fritzsch C, Nicolai T, Roell G, et al: Prevalence of asthma and atopy in two areas of West and East Germany. Am J Respir Crit Care med 1994;149:358– 364.
  33. Weiland SK, Mundt KA, Rückmann A, Keil U: Self–reported wheezing and allergic rhinitis in children and traffic density on street of residence. Ann Epidemiol 1994;4:243–247.
  34. Wichmann H: Environment, life–style and allergy: The German answer. Allergo J 1995;6: 315–316.
  35. Wichmann HE, Heinrich J: Health effects of high level exposure to traditional pollutants in East Germany – Review and ongoing research. Environ Health Perspect 1995;103(suppl):29– 35.
  36. Wüthrich B: Epidemiology of the allergic diseases; are they really on the increase? Int Arch Allergy Appl Immunol 1989;90:3–10.

    External Resources

  37. Wüthrich B: Epidemiology and natural history of atopic dermatitis. ACI International 1996;8: 77–82.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50